Protocols for ER Pelvics

From: V & S Alderman (alderman@flash.net)
Mon Aug 24 19:03:01 1998

I agree with Donna K.

I have a strong bias toward doing transvaginal sonography. I believe that my bias may come from working in an OB/GYN office setting for several years. Whenever we have a patient with a possible spontaneous abortion, ectopic pregnancy or with acute pelvic pain...the FIRST thing we do is a transvaginal sonogram. It takes such a short time to verify a viable first trimester IUP with transvaginal sonography. I've never understood why I was required to have a patinet fill via Foley when I could usually answer the diagnostic question with a quick, realtively painless transvaginal exam.

To my mind, for first trimester pregnancies and acute pelvic pain in an ER setting, transvaginal scanning should be the first thing done. Then, if more information is needed...a transabdominal scan could be performed with bladder distension via Foley.

I have actually stood between an obstetrician and radiologist on an ER call with a patient on the table who had a positive HCG, acute pain and bleeding. The radiologist was insisting on a Foley and transabdominal scan. The OB said "WHY? Just do a transvaginal scan." In the end, the radiologist said that he/she was reading the exam...and they wanted the Foley and transab. scan. I did the transvag. first with the OB...viable IUP. Then, we had to cath the poor lady and take transab. images for the radiologist. WHY?

It seems to me that the most cost effective, efficient and patient friendly thing we can do is use the transvaginal scan as a first scan.

What do ya'll think?

Donna Kepple wrote: >
> Hold on! it is 1998!!! Transvaginal sonography IS pelvic sonography. I think
> this argument should have been over years age. We routinely take a look
> transabdominally only for masses that extend out of the focal zone of the
> transducer. You don't have to have the bladder full for this at all. The PELVIC
> sonogram is then done TRANSVAGINALLY.
>
> ______________________________ Reply Separator _________________________________
> Subject: Re: [Fwd: Protocols for ER Pelvics]
> ______________________________ Reply Separator _________________________________
> Author: buddy@redrose.net (JT or JL Tomko) at +INET
> Date: 8/23/98 5:13 PM
>
> >
> >Hello All,
> > I need to know policies from those of you who have an ER and
> >perform pelvics and first trimester pregnancies. In an effort to reduce
> >nosocomial infections and pt. discomfort, my ER has started refusing to
> >cathetrize and electing to oral fill instead. While I can understand the
> >motives, when a sonographer is being called out to perform a study I
> >personally feel that we should not have to wait while the patient fills
> >by mouth. Doesn't this method defeat the "emergency" nature of the
> >procedure? Also, these patients have probably already had an "in and
> >out" cath for a U/A. Most of the other hospitals in town have standing
> >orders for catheterization. What do you do? I need to know either way.
> >Thanks for your help. Rene' Davis RDMS,RVT
>
> Rene',
>
> Our institution will place a foley catheter for ALL emergency examinations.
> When the ER doesn't want to do so the argument/discussion is raised to the
> emergency of the procedure. Our Rads argue if the patient is P.O.
> hydradtion the surgeons will have our heads with anesthesia not too far
> behind! If the patient is not a potential for surgery the case is not an
> emergency. Occasionally we have a patient refuse the foley and the
> examination is scheduled for a specific time as the patient fills via the IV
> route or chooses to come back the next morning with a full bladder.
>
> Good luck on this issue.
>
> Janet

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